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The book “Psychotherapy (Sattvavajaya Chikitsa) in Ayurveda” written by the well known author Professor Ajay Kumar Sharma & Associates is a complete and comprehensive treatise on the subject. This is the first book in English which deals with the subject in all completeness and clarity covering all aspects of “Psychotherapy” as described in various modern medical texts and various treatise of Ayurveda. The entire text is richly supported with original reference from Ayurvedic classics. Latest information regarding Psychotherapy has been incorporated with the objective of providing basic knowledge to readers. The book is meant especially for Ayurvedic students, physicians and teachers for creating awareness among masses about the dependable holistic approach of Ayurveda in the management and prevention “Mental Diseases.”
Ayurveda has always laid a special emphasis on the maintenance and promotion of health and prevention of disease rather than on the curative aspects. In modern science of medicine continuous and prolonged use of sedatives, tranquilizers, anxiolytics and hypnotics for treating various mental ailments has resulted in rebound phenomenon and drug dependence causing further frustration and decline in mental health status. Ayurveda propounds many methods to boost up mental health. The available literature in Ayurvedic texts regarding mental health and mental disorders is very little and in a scattered form. Although pharmacological management for certain mental disorders has been described elaborately but description of non-pharmacological management is very brief. Therefore, there is a dire need to develop an alternate non-pharmacological approach equivalent to psychotherapy of modern medicine for the management of mental diseases. On the basis of description and similarities in the approaches of both systems of medicine, Sattvavajaya Chikitsa of Ayurveda can be developed as an Ayurvedic substitute for modem psychotherapy. The principles of psychotherapeutic management of various mental disorders as described in Ayurvedic classics and allied literature can be modulated in a form, which can serve the purpose of psychotherapy.
Professor Ajay Kumar Sharma, one of the main authors of the book was born on May 31St 1954, graduated in Ayurveda with Medicine and Surgery from A. & U. Tibbia college, New Delhi in 1976 with throughout top rank career. He completed his M.D. (Ay.) and Ph.D. from B.H.U. Varanasi under the guidance of his illustrious mentor Prof. R.H.Singh, presently Professor Emeritus, Faculty of Ayurveda, I.M.S., B.H.U., Varanasi — U. P. and Ex-Vice Chancellor, Rajasthan Ayurveda University, Jodhpur.
Prof. Sharma is now the Director, Professor and Head of P. C. Department of Kayacikitsa at National Institute of Ayurveda, Jaipur. In the capacity of a reputed Ayurvedic physician, a capable teacher and outstanding researcher, Professor Sharma has published 11 standard books on Ayurveda and over 216 research papers in various journals of National and International reputation. He is recipient of Rashtriya Ekta Samman in memory of Late Shri Rajiv Gandhi, 2007 and many more awards and prizes for out standing services, achievements and contributions in the field of Ayurveda. He has contributed a chapters to the prestigious volumes on Ayurveda — Kayachikitsa — Panchakarma published by CRC Press, Boca Reton-London-New York-Washington, and Argentina Prof. Sharma has produced 47 M.D.(Ay.) and 11 Ph. D. under his guidance. He is the expert member of several important national level committees. Prof. Sharma has visited Serbia, South Korea and Malaysia for propagation of Ayurveda.
Ayurveda having its origin from Vedas is an eternal medical science covering all the aspects of life, health, disease and treatment. It has philosophic, holistic and humanistic approach. Which is life and health oriented. It treasures physical, psychological and spiritual well being of an individual and represents total health of a human being in a holistic way. The spirit of Darshana is the fundamental basis of Ayurvedic principles. Dharma, Artha, Kama and Moksha are the prime goals of life constituting the root cause of health. To achieve all these things, the human life has been considered as the invaluable opportunity and one needs a healthy and peaceful life. The aim of our ancient society was to achieve these goals by having a smooth, sound, calm, steady and healthy life style. On the other hand, in today’s modem era life has become so sophisticated that changes in life style and dietary habits along with over ambitiousness lead to increased mental stress, which acts as a predisposing factor to cause various psychological disturbances and mental disorders. Therefore, today’s metaphysical society has been facing stressful situations and every day changing life style. As a result anxiety, depression, insomnia, stress related disorders and other mental illnesses are coming into existence like forest fire and the present era has become the era of psychiatric problems. Statistical data shows that one out of ten; in the population suffers from psychosocial disturbances. Ayurveda has always laid a special emphasis on the maintenance and promotion of health and prevention of disease rather than on the curative aspects. In modem science of medicine continuous and prolonged use of sedatives, tranquilizers, anxiolytics and hypnotics for treating various mental ailments has resulted in rebound phenomenon and drug dependence causing further frustration and decline in mental health status. Ayurveda propounds many methods to boost up mental health. The available literature in Ayurvedic texts regarding mental health and mental disorders is very little and in a scattered form. Even then, the line of treatment for the management of mental diseases has been mentioned. Although pharmacological management for certain mental disorders has been described elaborately but description of non- pharmacological management is very brief. Therefore, there is a direct/urgent/specific need to develop an alternate non- pharmacological approach equivalent to psychotherapy of modem medicine for the management of mental diseases. Keeping this in view Sattvavajaya Chikitsa mentioned in Ayurvedic classics can be developed as a new concept of Ayurvedic psychotherapy.
In Ayurvedic system of medicine, Chikitsa has been categorized under three dimensions as follows:
1. Daivavyapashraya (Divine Therapy) to combat Daivakrit diseases.
2. Yuktivyapashraya (Rational Therapy) a planned treatment based on fundamental principles of Ayurveda.
3. Sattvavajaya (Psychotherapy) to control the mind by withdrawing it from undesired objects.
As there is a detailed description of rational therapy for somatic diseases in Ayurvedic classics, similarly Sattvavajaya implies the remedies for psychic disturbances. Acharya Charaka was the first person to mention the word Sattvavajaya but only once. The concept of Sattvavajaya has been described in a brief and concise form but its applied aspects have not been mentioned anywhere. An elaborate description of other psychotherapeutic procedures is available not only in Ayurvedic literature but also in spiritual philosophical texts like Shrimad Bhagwad Gita, Vedas and Upnishadas. Lord Krishna was the first counsellor who delivered the message of Gita to Arjuna in the battlefield of Mahabharta when Arjuna got depressed. This is a beautiful example of counseling which is a sort of psychotherapy.
In the definition of Sattvavajaya given by Acharya Charaka “Sattvavajaya punar ahitebhyo arthebhyo manonigraha”, there are three words Arhta, Artha and Manonigraha. The word Arhta means something unwholesome to the other, Artha meaning object of a sense faculty and Manonigraha refers to control of mind. Thus, Sattvavajaya is a technique controlling or restraining the mind from desires for unwholesome objects, which can be achieved by increasing Sattva.
However, whatever available regarding Sattvavajaya is very concrete and fundamental based on which the whole concept of psychotherapy can be explored.
Pragyapradha (intellectual blasphemy) one of the basic three fold aetiological factors causing a disease is mainly responsible for causation of mental disorders. All the ailments are the direct consequences of impairment of Dhee (intellect). Dhriti (patience) and Smriti (memory) which constitute Pragyapradha. Sattvavajaya or control of mind is a typical approach, which not only prevents the impairment of Dhee, Dhriti and Smriti but also brings them to normalcy resulting in the maintenance of harmony between these factors. In another reference quoted in Charaka-Samhita, regarding the control of mind one should keep oneself established in one’s own self after knowing the real nature of soul and attaining the height of spiritual wisdom, which can be achieved by development of Gyana i.e. true knowledge of self and soul.
The psycho supportive techniques like assurance, consoling the patient by proper guidance and suggestions, replacement of emotions, giving sudden shock, provision of favourable environment and psycho-shock therapy are also deemed a part of Sattvavajaya as they come very much within the limits of its definition. A critical analysis of the definition brings to light the hidden treasure of the concept of Sattvavajaya.
Conventional psychotherapy in modem medicine plays a significant role in the management of mental illnesses and other medical conditions associated with psychological components. It aims at supporting the patient and changing his disturbed personality, attitude, thinking and behaviour towards the present circumstances. In Ayurveda, no such type of therapy has been described in detail. Therefore, it was thought to develop an approach that may be equivalent to the conventional psychotherapy of western modem medicine. Hence, efforts have been made to develop the concept of Ayurvedic psychotherapy on scientific lines.
1. | Ayurvedic Concepts | 3-126 |
Concept of Ayu | 3 | |
Concept of Manasa | 11 | |
Concept of Sattva | 55 | |
Concept of Manasa Swasthya | 62 | |
Concept of Manasa Roga | 66 | |
Concept of Sattvavajaya | 102 | |
2. | Modern Review | 127-163 |
Concept of Mental Health | 127 | |
Concept of Mind | 137 | |
Concept of Psychotherapy | 142 | |
3. | Clinical Review | 164 |
4. | Discussions | 180 |
5. | Summary | 195 |
6. | Conclusions | 199 |
7. | Bibliography | 200 |
Abstract
In Ayurveda, three modes of healing are narrated, viz. Daiva-Vyapashraya, Yukti-Vyapashraya, and Sattvavajaya Chikitsa. In the present study, an effort has been made to assess the effect of Sattvavajaya Chikitsa on both Shareera and Manasa Doshas. Similarly, the impact of Yukti-Vyapashraya Chikitsa on both kinds of Doshas has been observed. The psychosomatic disease selected for the study was Manasa-Dosha Ajeerna. The standard drug taken for Ajeerna was Shunthi, while for Sattvavajaya “Trance/Clinical Hypnosis” was applied on the patients. The study was carried out on 27 patients suffering from Ajeerna and having a significant stress score. Patients were divided into two groups with simple random sampling method: Group S was treated with Shunthi tablet, while in group PS, placebo (rice powder tablet) along with Sattvavajaya Chikitsa was provided to the patients. Duration of the treatment was 10 days. Classical signs and symptoms of Ajeerna were studied before and after treatment. Amongst the registered patients, 25 patients completed the course of treatment while 2 dropped out. Group S had shown significant improvement in Vataja and Kaphaja symptoms, while group PS showed significant effect on Pittaja symptoms. In TamasikaManobhavas causing Ajeerna, group PS had shown significant improvement, while group S showed significant and highly significant effect on Rajasika and Tamasika Bhavas, respectively.
Introduction
It is a well-accepted truth that body and mind follow each other in various consequences.[1] This relationship between the body and the mind is actually a gross reflection of the inter-relationship between Shareera and Manasa Doshas. A vast difference of dimensions is observed at this particular stage which is actually a difference of extensions to which the matter and the fundamental forces have reached, respectively. Therefore, interrelationship of Doshas is generally understood on the basis of Panchbhautika constitution of Tridoshas and Trigunatmaka composition of Panchamahabhutas. This calculative way of prediction illustrates the schemata of quantitative relationship of both kinds of Doshas, but such a method of envisaging the Trigunatmaka composition of Shareera Doshas sometimes creates a controversy or confusion and may lead to fallacies, e.g. as per the quantitative parameters Kapha Dosha is “Tamobahula,” but Acharya Sushruta has indicated Kapha to be “Sattvagunopapanna.”[2]
Thus, in the aspect of quantity, Pitta dominates in Sattva, whereas in the aspect of quality, Sattva of Kapha overrules. This mystification can be solved only after analyzing the interrelationship of Doshas thoroughly. Till date, no debate has been done regarding the qualitative affiliation of both kinds of Doshas. Hence, the whole phenomenon of their evolution, functioning, and dissolution requires a deep study to better understand their interrelationship.
Triskandha of Ayurveda, i.e. Hetu, Linga, and Aushadha all are pervaded by one or other shade of interrelationship of Doshas. As the Shareera and Manasa Doshas follow each other also in a diseased condition,[3] it becomes inevitable to concentrate on their interrelationship while giving the treatment and also at the time of following the codes and conducts of Swasthavritta and Sadvritta in rationale of their prevention.
Aims and objectives
To assess the effect of Shareera and Manasa Doshas on Ajeerna Vyadhi in patients having considerable mental stress level and status identification of the Shareera and Manasa Doshas involved.
Management of the imbalanced state of the Shareera and Manasa Doshas in Ajeerna by giving Aushadha and Sattvavajaya Chikitsa and to assess the effect of both the therapies on reciprocal Doshas.
Materials and Methods
Patients having classical signs and symptoms of Ajeerna with significant stress score, attending the OPD and IPD of IPGT & RA, Jamnagar were selected without any bar of cast, religion, occupation, and sex.
Research design
It was an open clinical placebo control trial (study).
To know the mental stress level in the patients, GHQ-12 was used.
Statistical design
Paired “t” test was used to assess the effect of therapy in each group.
Chi-square test was applied to compare the effects of both groups on Manasa as well as Shareera Doshas.
Inclusion criteria
Patients suffering from Ajeerna – chronicity of maximum 2 weeks.
Patients with decreased Agni-Bala and considerable mental stress score.
Patients between 18 to 60 years of age.
Exclusion criteria
Patients without considerable mental stress score.
Sufferers from diseases other than Ajeerna.
Patients with the symptoms >2 weeks.
Patients on drugs causing hyperacidity.
Grouping and posology
Patients were randomly divided into two groups:
Group S: Tablets of Shunthi each of 500mg; 2 tablets after meal twice a day with luke warm water were provided to 13 patients.
Group PS: Tablets of wheat flour as a placebo each of 500mg; 2 tablets after meal twice a day with luke warm water were given along with Sattvavajaya Chikitsa to 14 patients.
Patients of both the groups were treated for a duration of 10 days.
Assessment criterion
Ajeernasya Nidaanabhoota Manobhaava-Pareekshanam[4]
Doshika Lakshanas of Ajeerna
All the physical manifestations of Ajeerna were divided into three categories as Vataja, Pittaja, Kaphaja, and after that gradations of each manifestation were made in the way similar to that of the Manobhavas stated above.
Criteria for assessment of overall effect of therapy
Total effect of therapy was assessed by taking into account the overall fall in the grades of Manasa bhavas causing Ajeerna and improvement in the signs and symptoms of the same disease after treatment. Overall effect of therapy was determined by measuring the obtained results according to the grades mentioned below:
Observations and Results
The clinical study was carried out on total 27 (group S: 13 and group PS: 14) patients. The general observations regarding some important aspects are as follows:
Out of 27 patients, 25 completed the treatment while 2 dropped out. Maximum, 29.63% of the patients belonged to 30–40 years age group 70.37% were males, 77.78% patients were married. Totally 40.74% patients were occupied with stressful jobs, while 18.52% were laborers.
Maximum, 40.74% patients were having Teekshnagni (at physiological level), while Mandagni was found in 14.81% of the patients. Habit of Vishamashana was found in 29.63% patients, were habitual of doing Vishamashana, while the habit of taking nap immediately after lunch was found in 55.56% patients. Totally 40.74% of the patients were having Antarmukha type of personality.
Vata-Pitta, Pitta-Vata, and Kapha-PittaShareera Prakriti was found in 18.52%, while 25.93% of the patients were having Vata-Kapha Prakriti. Totally 29.63% of the patients were of Raja-Sattva Manasa Prakriti, while 25.93% patients were having Sattva-Raja Prakriti. 14.81% of the patients were having Raja-Tama or Tama-Raja Prakriti, while patients having Sattva-Tama or Tama-Sattva Manasa Prakriti were 7.41%. Maximum, 51.85%, of the patients were having Madhyama Sattva.
Group S shown significant effect on Chinta and Dwesha, while on Bhaya, Krodha, Shoka, and Dainya, it showed highly significant effect [Table 1].
Table 1
Effect of placebo + Sattvavajaya Chikitsa in group PS was found to be significant on Krodha and Shoka, while on Eershya, Dwesha, and Lobha, its effect was insignificant. In the Lakshanas - Shoka and Krodha, this group showed significant effect [Table 2].
Table 2
Group S shown significant effect on maximum Lakshanas of Vata, viz. Vishtambha, Sadanam, Angamarda, Katigraha, Shiraso ruk, and Vibandha, followed by two Kaphaja lakshanas (66.67%) Chhardi and Arochaka. The effect of Shunthi was minimum on Pittaja Lakshanas, among which it showed significant effect on Bhrama only [Table 3].
Table 3
Effect of therapy on Sharirika Lakshanas in Group S
The effect of PS group on Bhrama was significant, while on Avipaka it showed highly significant effect. In Vatika lakshanas Sadanam, Angamarda, and Katigraha, it showed highly significant effect [Table 4].
Table 4
Effect of therapy on Sharirika Lakshanas in Group PS
Except Dainya, on all the above-mentioned Rajasika and Tamasika Manobhavas, Shunthi showed effect which indicates that the difference between the effects of S and PS groups on Raja and Tama is not by chance. Dainya is a Tamasika bhava which produces due to Vatakshaya. The difference between the therapeutic effects of groups S and PS is significant, hence the effect of Shunthi on Dainya may be by chance [Table 5].
Table 5
Comparative effect of therapy on Manobhavas causing Ajeerna
In the same way, χ2 applied on the characteristics of Ajeerna – 8 Vataja, 3 Pittaja, and 3 Kaphaja Lakshanas – reveals the fact as follows:
In all the 14 parameters, group PS has shown effect which indicates that the difference between the effects of groups S and PS on the manifestations of Ajeerna are not by chance.
Discussion
Manasa-Dosha Ajeerna[5is a psychosomatic disease. Due to Shoka, Bhaya, etc., Manasa Bhavas at significant level, Manasa-Dosha Vaishamya takes place which in turn causes Shareera Dosha Vaishamya. Provoked Shareera Doshas affect Agni and alter its natural status. Hence, food cannot get digested properly within the correct time period. Here, as the root cause of indigestion is psychological upset, this pathological condition is called “Manasa-Dosha Ajeerna.”
Probable mode of action of placebo
First of all, it creates Ashvashana and Anuraga in the mind of the patient as he feels that he is being treated, his pain is getting consideration from others. Due to this Sanga of Rajas, it attaches with particular receptor. Hence, normal physiology re-establishes because of Agnisamya and Vatanulomana. Here, a hypothesis can be put forth. Receptors, if counted as Indriyas, and process of recognition as Sparsha, then it can be inferred that placebo may affect Vata and Rajas. But when matter/particle is needed, it may not reach the target. Thus, placebo may show its effect as a drug up to a certain level, but after that if certain chemical is needed or any peculiar charged particle is needed, then the placebo may not show significant effect.
Probable mode of action of Sattvavajaya
In the PS group, placebo is not the chief remedy, rather the patient's mind diverts toward the new process of trance and the hypnotherapist. As Sattvavajaya is an Adravyabhoota Chikitsa, the mode of its action can be envisaged at the level of Trigunas. Jnana or knowledge is of two types – Indriya-Sapeksha and Indriya-Nirapeksha Jnana. Till the output continues, one cannot concentrate well on one particular subject. By progressive muscle relaxation and suggestions for withdrawal of Indriyas and Mana from their Vishayas, one may obstruct the flow of Indriya-Sapeksha Jnana and by concentrating on single topic or suggestion help to prevent the Indriya-Nirapeksha Jnana. Due to these hurdles, intensity of mind (activities) may reduce. So, Raja and Tama subside and Sattva gets strength. This improves the mental condition of the patient. Probable mode of action of Shunthi is shown in Figure 1.
Probable mode of action of Shunthi
Discussion on effect of therapy
Effect on psychological causes of Manasa-Dosha Ajeerna
Bhaya: In Bhaya, PS group showed statistically highly significant improvement, i.e. 24.3%.
Krodha: In Krodha, S group showed highly significant relief while PS showed 54.3% relief which is statistically significant.
Dwesha: PS showed maximum effect on Dwesha, i.e.18.4%, which is significant.
Chinta: Both S and PS groups showed highly significant relief in Chinta, which is 25.6% and 28.9%, respectively.
Shoka: In Shoka, PS group showed 21.7% relief, i.e. statistically significant.
Dainya: PS group showed maximum, i.e. 65.4%, relief in Dainya, which is statistically highly significant.
Group S showed highly significant effect on Chinta and Krodha, a Shunthi is Ushna and Kaphavatanut, its therapeutic effect on Chinta caused by Raja/Vata can be estimated. On the other hand, it reduces Krodha also. Here, the mode of its action is somewhat difficult to envisage. Actually, while describing the actions of Trigunas, Krodha has been included in both groups – Rajasika and Tamasika Bhavas. It is obvious that generation of Krodha from each of them would have a separate mode of action. Raja as a part of Pitta can be correlated here, but involvement of Tamas requires a deep logic to get explained.
As described in Shreemad Bhagvat Geeta, due to Dhyana of Vishayas, one gets affiliated to them and when his desire is not fulfilled he gets caught by anger. In Rajasika persons, this affiliation/Sanga is not too strong, rather it is fluctuating due to instability of Raja, while in Tamasika Purushas, this desire or Kama is very strong and obligatory. So, when they do not get the desired thing, they get irate and the sternness of their anger is so much severe that it may lead to Sammoha. Thus, Krodha due to Tama includes Avarana of Buddhi, Dhruti, and Smruti which can be ruptured through Teekshnata of dravyas like Shunthi.
The PS group showed marked effect on all the above-narrated Manobhavas as Avajaya of Mana due to Udeerana of Sattva is the real treatment for all undesired psychological states.
Effect of therapy on somatic features of Manasa-Dosha Ajeerna
On Vataja Lakshanas: In Vishtambha, Shunthi showed 31.8% relief, i.e. highly significant, while in Sadanam and Angamarda, PS group showed 35.3% relief, both of which are statistically highly significant.
Trance causes relaxation of muscles and it also stops inputs of grief and pain from reaching the brain. Thus, it shows better result on muscular pain. That is why it showed good effect on Angamarda. It also subsided Prushthagraha and Katigraha by 55.9% and 47.9%, respectively, which are statistically highly significant. Sometimes, during trance, the person tries to control his muscles from getting relaxed. This action is performed by conscious mind. It results ultimately into headache, neck stiffness, etc. So, in PS group, Shiraso ruk did not improve; rather, it had been increased which shows patient's active involvement in the procedure of trance. Shunthi has shown significant effect on Shiraso ruk. On Pravahanam, none of the groups showed significant effect, while on Vibandha, group S showed statistically significant effect.
On Pittaja Lakshanas: On Ateesara, Shunthi showed maximum 62.5% effect, but it is statistically insignificant; while PS group showed significant, i.e. 50%, relief in Ateesara. Shunthi shows this effect due to its Grahi Guna, while Sattvavajaya acts on negative emotions and anxiety causing stimulation which increases peristalsis movement. On Jvara, PS group showed significant effect, i.e. 11.1%. Both the groups showed significant effect on Bhrama, between which PS group showed maximum, i.e. 58.3%, relief.
On Kaphaja Lakshanas: Shunthi showed maximum, i.e. 55.6%, improvement in Chhardi which is statistically significant, while in Arochaka it showed 51.4% relief which is highly significant. Both the effects might be because of Kaphashamaka and Pachana properties of Shunthi. On Avipaka, only PS group showed significant effect, i.e. 27.2%. In Manasa-DoshaAjeerna, Avipaka is caused mainly due to Agnimandhya for which certain emotions are responsible. Sattvavajaya acts on these particular Bhavas. This may be the cause of its better results in curing Avipaka.
Effective therapy
Shunthi did not show comparatively much effect on any of the Shareera or Manasa Doshas. PS group showed maximum effect on Pitta, i.e. 39.9%, and on Manasa Dosha-Tama, i.e. 29.03%, [Chart 1].
Effect of therapy on Shareera Doshas and Manasa Doshas
Overall effect of therapy
Complete remission was found in none of the patients in PS group, while in S group 7.69% of the patients got complete relief. Moderate improvement was found in maximum, i.e. 42.86%, of the patients belonging to PS group, while in groups, mild improvement was found in maximum number of the patients, i.e. 53.85%. In S and PS groups, the number of uncured patients was 23.08% and 28.57%, respectively [Table 6].
Table 6
Conclusion
Shareera and Mana are related with each other through their fundamental functional forces, viz. the Tridoshas and Trigunas, respectively.
At the level of Kriyatmakata, both of the Doshas have proved their interrelationship by responding to mutual remedies.
Group S showed significant improvement in Vataja and Kaphaja symptoms, while group PS showed significant effect on Pittaja symptoms. On Tamasika Manobhavas causing Ajeerna, group PS showed significant improvement while group S showed significant and highly significant effect on Rajasika and Tamasika bhavas, respectively.